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  • 1. Institute for Microbiology, Medical Faculty of Masaryk University and St. Anna Faculty Hospital in Brno Agents of urinary tract infections
  • 2. U rinary tract infections (UTIs)
    • Frequency of UTIs:
    • The 2nd most common infections (after respiratory ones)
    • In adults: the most common infections
    • Afflicting mainly females (because of shorter urethra)
  • 3.  
  • 4. Examples of UTIs I
    • The most common UTI:
    • Cystitis - develops ascendently caused by intestinal microflora
    • Symptom s:
    • dysuria (difficult urination with sharp and burning pain)
    • pollakisuria (urgent need to urinate accompanied by urination of a small amount of urine only)
  • 5. Examples of UTIs II
    • Other UTIs:
    • mainly pyelonephritis (more serious)
    • origin: ascendent or hematogenous
    • Symptom s:
    • fever, chills, flank pain, or costovertebral tenderness, urinary frequency, dysuria, hematuria
    • urethritis – will be dealt with STD
  • 6. Etiology of UTIs
    • Proportional representation of microbes differs in :
    • non-complicated UTIs
    • infections accompanying structural abnormalities (prostatic hypertrophia, urinary stones, strictures, pregnancy, congenital defects, permanent catheters)
    • infections accompanying functional disorders (vesicoureteral reflux, neurological disorders, diabetes mellitus)
  • 7. Etiology of non-complicated UTIs
    • 80 % Escherichia coli
    • 10 % enterococci ( Enterococcus faecalis )
    • 5 % Proteus mirabilis
    • other enterobacteria ( Klebsiella pneumoniae,
    • Kl. oxytoca, Ent. cloacae, C. freundii etc.)
    • Streptococcus agalactiae
    • coagulase neg. staphylococci ( S. epidermidis,
    • S. saprophyticus, S. haemolyticus etc.)
    • yeasts (mainly Candida albicans )
  • 8.  
  • 9.  
  • 10. http://biology.clc.uc.edu
  • 11. Etiology of complicated UTIs
    • circa 80 %: Escherichia coli
    • Klebsiella pneumoniae
    • Proteus mirabilis
    • Pseudomonas aeruginosa
    • enterococci
    • other enterobacteria
    • acinetobacters
    • other G-neg. non-fermenting rods
    • candidae
  • 12. Lege artis taking a urine sample
    • Only after a thorough cleaning of genital incl. external orif f icium of urethra by means of soap and water
    • Take the middle stream of urine only
    • Use a guaranteed sterile vessel
    • Pour it into a sterile tube & stopper promptly
    • If not possible to process it within 2 hours , place the specimen into 4 °C for 18 hours at most
  • 13. http://www.naturalnews.com/cartoons/Expensive_Urine_600.jpg
  • 14. Semi - quantitative examination of the urine sample – I
    • We are interested
    • not only in the kind of microbe present in the urine sample, but especially
    • in the amount of the microbe
    • Why are we interested in the number of microbes in 1 ml of urine?
    • Because
    • high numbers only stand for the UTI
    • low numbers mean usually contamination acquired during urination
  • 15. Semi - quantitative examination of the urine sample – II
    • Therefore , the urine is inoculated on culture media by means of a calibrated loop , usually taking 1 μl of urine
    • In this case
    • 1 colony means 10 3 CFU/ml
    • 10 colonies mean 10 4 CFU/ml
    • 100 colonies mean 10 5 CFU/ml
    • (CFU = colony - forming unit = 1 cell)
  • 16. Significant concentrations of bacteria in urine 10 5 Dubious urine pathogen 10 1 Any Suprapubic punction 10 5 Any Middle stream, no symptoms 10 3 Primary urine pathogen Middle stream, symptoms present Significant number (CFU/ml) Type of microbe Type of specimen, symptoms
  • 17. Therapy
    • T rimethoprim-sulfamethoxazole
    • Nitrofurantoin
    • Cephalexin
    • Fluorochinolones
    • Amoxicillin-clavulanate
    • in complicated UTIs ATB sensitivity assessment
    • ESBL strains
  • 18. Homework 3 – solution Paulus Peeter Rubens (1577-1640): Goddess of health Hygiene (1615)
  • 19. Homework 3 – detail Paulus Peeter Rubens (1577-1640): Goddess of health Hygiene (1615)
  • 20. Homework 4 Who painted this picture and what is its name?